Ramblings of an Emergency Physician in Texas

Everyone has their own preferred method of dealing with forged prescriptions. Ryan at EclecticEsoteric recently asked what I would do. It so happens that Andrew at PharmCountry has a related post, so it seems an opportune time…

When you’ve got a forged or altered prescription, there are two basic things you SHOULD do.

1) Contact the prescriber. Verify that it has been forged or altered.
2) Initiate a PharmAlert, the details of which can be obtained by contacting your state’s board of pharmacy. I believe this is how such an alert is usually initiated anyway — I’d say “always” but I haven’t worked in every state, so that’s impossible for me to know.

Prescription alteration and outright forgery comes up sometimes in the ED, and I’ve had several kinds happen.

Right after I moved to this job (about 5 years ago) I started getting calls from pharmacies to verify called-in prescriptions for phenergan with codeine. This immediately raised my eyebrows, as I prescribe that maybe 4 times a year, and we don’t typically call in prescriptions. All the pharmacies I called back said the caller had the rap down, knew exactly what to say, had my DEA, etc.

Interestingly, the pharmacists had a hunch, despite the good call-in rap, that there was something fishy so they called to verify (experience counts). I thanked them all, then asked they call the cops if someone actually showed up to pick it up, as I’d had a bunch of these calls. I never heard more about it, and it tapered off over about 3 weeks. The caller no doubt just got someone else’s’ DEA number. (And what a weird drug to abuse…)

The big winner in this category goes, though, to this exchange:

Charge Nurse: Gruntdoc, did you write a prescription for Marinol to a patient recently?

Me: No, why?

CN: Well, there’s a parole officer on the phone who has a parolee whose drug screen came back positive, but has a prescription for Marinol on one of our pads with your name on it. As an excuse.

Me: Heh. Nope, I’ve literally never written a prescription for marinol in my life.

This was relayed, and in short order I got a fax of the prescription, and it was fairly good: the writing style looked hurriedly-efficient, there was a written-out quantity, the Sig line was what you’d expect. My signature wasn’t anywhere close, and the really interesting part was the DEA number didn’t follow one of the really basic tenets of how they’re encoded. Any pharmacist would have picked it up in less than a second, so this was never presented to be filled, it was written to attempt to stay out of jail.

CN: They wanted you to type out a letter, on official letterhead whether or not this is your prescription. I told them we were too busy for that, so they agreed on a hand-written response.

Me: (Again noting our CN’s are very smart) Thanks!

So, some scribbles and my real signature later, off went my reply. I never heard any more about it, though I wonder if it’s a crime to carry around a forged prescription if it’s never presented to fill a medication (I doubt it). It probably is a crime to use a forged script to stay out of jail on a probation violation, but then they wouldn’t need any kind of forgery charge, I’d think, they’ve got all the evidence they need in the little jar.

And, it’s 2007! Why are we hand writing things on little slips of paper and giving them to patients to then literally hand-carry to pharmacies? I’m going to gripe my head off when the EMR comes to my ED, but if it comes with an automated way to transmit scripts to pharmacies I’ll gripe a little less loudly.

Some background on prescription fraud, from a defense-attorney site (good info).